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[ESC2008]Eric Eeckhout教授访谈:介入心脏病学领域

作者:  EricEeckhout   日期:2008/9/12 9:52:00

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As the coordinator of the interventional cardiology program of the annual meeting of the European society of cardiology, you have given lectures in EuroPCR this year. Would you like to introduce the highlights of EuroPCR 2008 at ESC?

International Circulation:As the coordinator of the interventional cardiology program of the annual meeting of the European society of cardiology, you have given lectures in EuroPCR this year. Would you like to introduce the highlights of EuroPCR 2008 at ESC?

《国际循环》:作为欧洲心脏病学会年会介入心脏病学项目组织者,您在今年EurPCR上有很多发言。可否介绍一下EurPCR 2008的精彩片断?

Eric Eeckhout:We had focus sections focusing specific part of ESC. There are two focus sections: focus practice and focus imaging; in the focus imaging part we had best of EuroPCR at ESC; focus is based on everything done around the patient, so it’s patient presentation, interactive discussion, literature review, all in one section; and what we did is that we showed two recorded cases that were reshaped for presentation, intellectual discussion. And one of the cases was a case from China, from Prof. Gao, Institute of Fu Wai, with left main stent in a young lady; we had a lot of discussion. And then if you come to the highlights, we had a highlights overview, with our presentation of our success in PCI and documents. Prof. Pomar who is a surgeon from Barcelona and Dr. Wijns from Aalst, they both to get it presented the highlights. The highlights in brief they were more of consensus documents: I would say that there were they reconfirmed the safety of current PCI technology including the stenting; the highlight precautious attitude towards multivessel disease and left main lesion; we have seen that also we should probably readjust a little bit to think about it. There were other discussions; probably the most important one was on the percutaneous aortic valves; there were clear consensus that it has to be a teamwork, team preparation of the patients, and teamwork of intervention. There were, if I remember well, also some issues on carotid stenting which is sometimes controversial and we all had some clear statements on that. That’s what I would briefly summarize EuroPCR. To be honest from the late breaking trial, there were no major presentations.

Eric Eeckhout教授:我们有焦点环节,聚焦欧洲心脏病学会的具体问题。主要有两个焦点:应用和成像。成像部分是EurPCR年会的最精彩部分,聚焦关注患者身边的所有问题,因此包括病例展示,交互讨论,文献综述,多合一。我们在会上将两个记录在案的病例加以润色,向与会者展示,集中讨论。其中有一个病例来自中国,是由阜外心血管研究所的高教授所提供的,是患左冠状动脉主干血管疾病的一名年轻女性。与会者都积极参与了讨论。除此之外,我们还有热点综览,我们展示了在经皮冠脉介入治疗(PCI)方面的成功经验和文档。外科医生Pomar教授,以及来自巴塞罗那的Gerald教授,一同展示了热点问题。简要地说,此次热点多为专家的一致意见,我能说上来的有比如重新证实了目前PCI技术,包括支架的安全性问题、对多支血管病变和左冠状动脉主干病变持谨慎态度,因此我们在这方面的看法可能应该略作调整。此外还有其它讨论,最重要的一个应该是经皮主动脉瓣介入技术。会上的一致观点认为它应当是团队协作,包括病人准备和介入过程的团队协作。如果我记得不错的话,还有一些关于颈动脉支架的讨论,这方面以往常有争论,会上对此有清楚的报告。以上就是我对这次EurPCR的简要概括。说实话,最新的临床试验方面没有什么重要的内容,仅展示了一项阿司匹林的临床试验。

International Circulation:With the development of interventional cardiology, do you think we come to an era of PCI? At present, we still focus on the safety profile of DES. You know, in China, there are more than 80% ACS patients implanted with DES if they are performed PCI. What do you think about it? Do you think DES is suitable for all patients and all lesions? What’s your opinion on DES safety?

《国际循环》:随着介入心脏病学进展,您认为PCI时代来临了吗?目前,我们依旧关注药物洗脱支架(DES)安全性问题。在中国,超过80%急性冠脉综合征的患者介入治疗过程中选择DES,您如何看待?您认为DES适用于所有患者和所有病变吗?您对于DES安全性有何见解?

Eric Eeckhout:I think Chinese colleagues at the end were right. We were very concerned of the Barcelona ESC 2 years ago. There was a lot of free action, counter-reaction; there was a set out of the academic results consultation, new differentiation of stent thrombosis. Finally, two years down the road then we had the main session yesterday on drug-eluting stents safety called 2 years of the Barcelona. Retrospective data, randomized trial data all presented that it is really safe. even you know, it’s surprising to see yesterday that even in available large-registry study, the safety of DES is clearly shown and quiet comparable to bare metal stents. So I think Chinese colleagues were right; we went down in our use of DES; they continue to use it and engaged a fair number, think it of all situations; what is unclear today for us is saphenous vein graft and on the other hand, primary PCI. Do we have considered of all setting in the large sample? I’m not sure. But on the other hand, maybe the only confusing things are very big vessels short lesions? Of course all those patients to have problems with antiplatelet therapy for whatever reason had to refuse antiplatelet. You don’t know how to stop; and they debated that you have to stop and you are really in trouble.

Eric Eeckhout教授:我觉得最后证明中国的同事们还是对的。他们两年前就对巴塞罗那欧洲心脏病学会年会特别关注。当时,讨论了很多自由反应、逆反应,一系列学术成果研讨,支架置入后血栓的新分型等。最后,两年过去了,昨天我们在巴塞罗那年会上主要进行的就是药物洗脱支架安全性的讨论。回顾性数据、随机临床试验数据全都表明它是安全的。甚至,令人惊讶的是昨天会上还展示了大规模样本研究的结果,清楚表明了药物系统支架具有足够安全性,可以媲美裸金属支架。所以我认为中国的同事是对的。我们减少药物洗脱支架的使用,他们则继续应用,并进行大样本研究,考虑到所有的情况。现在我们还不清楚的是隐静脉移植的问题,另一方面是急诊PCI。我们在大样本研究中考虑到所有情况了吗?我不能确定。但另一方面,可能最麻烦的问题是大血管小病灶的情况。当然,在抗血小板治疗时,可能出现各种原因导致病人无法接受抗血小板治疗。你不知道何时该停药,但是会上讨论说你必须停,这种情况确实很麻烦。

International Circulation:During these years, you have published some articles about treatment for multivessel disease. For such population, how should we optimize our therapy strategy?
《国际循环》:近年来,您发表了多篇有关多支血管病变的文章,对于这种患者,我们如何制定治疗策略?

Eric Eeckhout:It’s quiet simple. We have excellent information from SYNTAX. SYNTAX showed that probably what we should do in a synergetic approach with a surgeon is going to gather the patients’ profile, the angiogram in the whole picture, decide together if the patient is amendable for PCI surgery, that’s what SYNTAX showed us. And if the SYNTAX score is too high, this patient needs go for a surgery, because SYNTAX yesterday showed clearly that even if your lesion complexity is high, which corresponds to high SYNTAX score, the outcome is excellently comparable to those patients that have a low score. So the surgeon for the survival and complication rate doesn’t care about the lesion complexity while it is a big issue for the PCI. So if we have simple multivessel disease with a low SYNTAX score, this patient can definitely go for PCI, still knowing that there is a risk that they have to receive the cardiac revascularization because of their need for intervention is higher, then for a CABG. Then on the other hand I think that what we saw yesterday too, is that the left main has been a little bit reckoned down; maybe because left main is for single-vessel disease. SYNTAX showed that its patients do well in PCI, which is very important information for us.

Eric Eeckhout教授:很简单,我们从SYNTAX试验中得到了很好的数据。SYNTAX试验表明,与外科医生进行协作&

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